Reaching "The Other Half": Teacher Referral Increases Inclusivity in Intervention Research for Neurodivergent School-Age Children.

OBJECTIVE: Researchers employed two recruitment strategies in a school-based comparative effectiveness trial for students with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism. This study assessed the: 1) effectiveness of school-based referrals for identifying students meeting diagnostic criteria and 2) impact of eliminating requirements for existing diagnoses on recruitment, sample characteristics, and intervention response. METHOD: Autistic students and students with ADHD in schools serving underresourced communities were recruited for an executive functioning (EF) intervention trial over 2 years. In Year 1, school staff nominated students with previous diagnoses. In Year 2, school staff nominated students demonstrating EF challenges associated with ADHD or autism; previous diagnosis was not required. Study staff then confirmed diagnoses. RESULTS: More students were included in Year 2 (N = 106) than Year 1 (N = 37). In Year 2, 96% of students referred by school staff met diagnostic criteria for ADHD or autism, 53% of whom were not previously diagnosed. Newly identified students were less likely than previously diagnosed students to be receiving services and, for those with ADHD, were more likely to speak primarily Spanish at home. Previously diagnosed and newly identified students did not differ on other demographic variables or intervention response. Caregivers of previously diagnosed students reported more symptoms than caregivers of newly identified students for both diagnostic groups. Previously diagnosed students with ADHD had more researcher-rated symptoms than newly identified students. CONCLUSIONS: Recruitment for an intervention study using behavior-based referrals from school staff enhanced enrollment without compromising the sample's diagnostic integrity and engaged children who otherwise would have been excluded.

Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children With Developmental Delays.

Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.

Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes.

OBJECTIVES: School-based interventions with parent-training components might improve access among lower-income families to effective help for children with neurodevelopmental disorders. This potential might be realized, however, only if parents perceive the interventions as acceptable and therefore engage with treatment. METHODS: Parents (N = 124) of 3rd-5th grade students diagnosed with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder rated the acceptability of their child's treatment (one of two culturally responsive behavioral interventions). Parent engagement was measured through attendance at parent training sessions and the extent to which they read a corresponding workbook. RESULTS: Education and income correlated inversely with parent perceptions of treatment acceptability. Acceptability correlated positively with engagement, more strongly among lower-income families. Acceptability had an indirect effect on treatment outcome, mediated by parent engagement. CONCLUSIONS: Treatment providers should focus on strategies to increase parent acceptability, with particular attention to improving access for lower-income families.

Family Empowerment: Predicting Service Utilization for Children with Autism Spectrum Disorder.

Families of children with autism spectrum disorder (ASD) often utilize a variety of services. Relatively few studies have examined the relationship between family empowerment and service utilization for this population. The present study investigated the relationship between family empowerment and service utilization in families of children with ASD from the Pacific Northwest. Family empowerment did not predict the use of behavioral services or established related services. However, higher family empowerment was reported for families who reported use of complementary and alternative medicine. Implications for future research and clinical practice are discussed.

School-Based Autism Rates by State: An Analysis of Demographics, Political Leanings, and Differential Identification.

We reviewed federal special education data to determine school-identified prevalence of Autism Spectrum Disorder (ASD) and other disability categories by U.S. state. We also examined whether state-level policies, demographic factors, and rates of other eligibility categories are predictive of these state ASD rates. Results indicate that overall, 1 of 81 school-aged children are served under an ASD special education eligibility. State-level demographic factors, such as socioeconomic status and political leanings were highly predictive of rates of ASD. States with higher rates of ASD had lower rates of intellectual and learning disabilities, but higher rates of Other Health Impairment (OHI).

Examining Demographics in Randomized Controlled Trials of Group-Based Social Skills Interventions for Individuals with Autism Spectrum Disorder.

We reviewed the demographic reporting practices and diversity of participants in published randomized controlled trial studies of group-based social skills interventions (GSSIs) for individuals with autism spectrum disorder (ASD). A total of 17 studies met inclusionary criteria. Results of this review suggest that the majority of published RCTs reported on participant gender and race/ethnicity, with fewer studies including details on household income and caregiver education. Study samples generally lacked diversity, with an overrepresentation of participants who were male, White, and from upper-middle class backgrounds. Additionally, we found that nearly all GSSI studies focused on participants with average or high IQs, or were specifically classified as having a higher functioning sub-diagnosis within ASD. Implications and future directions for research are discussed.

Language Preference of a Multilingual Individual With Disabilities Using a Speech Generating Device.

Individuals with disabilities who are English learners (ELs) and communicate using speech generating devices (SGDs) may demonstrate a preference for instructional language and language output of their SGDs. The influence of interventionist language on the preference of SGD language output and frequency of mands was examined using an alternating-treatments design with an embedded concurrent-chain arrangement with a 10-year-old with Down syndrome whose heritage language was Spanish. Language preference assessment for ELs is recommended because heritage language may be preferred for children with disabilities who use SGDs.

Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research.

Low-income and ethnic minority families continue to face critical disparities in access to diagnostic and treatment services for neurodevelopmental conditions, such as autism spectrum disorder and attention deficit hyperactivity disorder. Despite the growing cultural diversity of the United States, ethnic minority children and families continue to be substantially underrepresented across research on neurodevelopmental disorders, and there is a particularly concerning lack of research on the treatment of these conditions in low-income and ethnic minority communities. Of note, there are currently no published studies on adapting autism spectrum disorder treatment for low-income Latino communities and relatively few studies documenting adapted treatments for children with attention deficit hyperactivity disorder in these communities. This article describes methodological considerations and adaptations made to research procedures using a Diffusion of Innovation framework in order to effectively recruit and engage low-income, ethnic minority, particularly Latino, families of children with neurodevelopmental disorders, in a comparative effectiveness trial of two school-based interventions for executive dysfunction.